1Amending Title 40 (Insurance) of the Pennsylvania Consolidated
2Statutes, providing for nondiscrimination by payers in health
3care benefit plans.

4The General Assembly of the Commonwealth of Pennsylvania
5hereby enacts as follows:

6Section 1.  Part III of Title 40 of the Pennsylvania
7Consolidated Statutes is amended by adding an article to read:

8ARTICLE M

9MISCELLANEOUS PROVISIONS

10Chapter

1191.  Nondiscrimination by Payers in Health Care Benefit Plans

12CHAPTER 91

13NONDISCRIMINATION BY PAYERS

14IN HEALTH CARE BENEFIT PLANS

15Sec.

169101.  Definitions.

179102.  Discrimination against willing providers prohibited.

189103.  Construction and application of chapter.

1§ 9101.  Definitions.

2The following words and phrases when used in this chapter
3shall have the meanings given to them in this section unless the
4context clearly indicates otherwise:

5"Health care benefit plan."  An insurance policy, contract or
6plan that provides health care to participants or beneficiaries
7directly or through insurance, reimbursement or otherwise.

8"Health care payer."  An individual or entity that is
9responsible for providing or paying for all or part of the cost
10of health care services covered by a health care benefit plan.
11The term includes, but is not limited to, an entity subject to:

12(1)  Chapter 61 (relating to hospital plan corporations)
13or 63 (relating to professional health services plan
14corporations);

15(2)  the act of May 17, 1921 (P.L.682, No.284), known as
16The Insurance Company Law of 1921, including:

17(i)  a preferred provider organization subject to
18section 630 of The Insurance Company Law of 1921; or

19(ii)  a fraternal benefit society subject to Article
20XXIV of The Insurance Company Law of 1921;

21(3)  the act of December 29, 1972 (P.L.1701, No.364), 
22known as the Health Maintenance Organization Act;

23(4)  an agreement by a self-insured employer or self-
24insured multiple employer trust to provide health care
25benefits to employees and their dependents.

26§ 9102.  Discrimination against willing providers prohibited.

27A health care payer shall be required to contract with and to
28accept as a health care benefit plan participant any willing
29provider of health care services. A health care payer shall not
30discriminate against a provider of health care services who:

1(1)  agrees to accept the health care payer's standard
2payment levels; and

3(2)  meets and agrees to adhere to quality standards
4established by the health care payer.

5§ 9103.  Construction and application of chapter.

6(a)  Construction.--This chapter shall not be construed to
7prohibit a health care payer from negotiating and paying rates
8higher than the health care payer's standard payment levels to
9one or more providers.

10(b)  Application.--This chapter shall:

11(1)  apply to all health care benefit plans that
12compensate providers on a fee-for-service basis, per diem or
13other nonrisk basis; and

14(2)  not apply to health care benefit plans regarding
15products that compensate providers on a capitated basis or
16under which providers accept significant financial risk in a
17formal arrangement approved by Federal or State authorities.

18Section 2.  The provisions of this act are severable. If any 
19provision of this act or its application to any person or 
20circumstance is held invalid, the invalidity shall not affect 
21other provisions or applications of this act which can be given 
22effect without the invalid provision or application.

23Section 3.  This act shall take effect in 60 days.